Bile Duct Obstruction

• Gallstones: a common cause of bile duct obstruction is gallstones. Bile is produced by the liver and contains bile salts, bilirubin, cholesterol, and water. It is stored in the gallbladder and when needed, the duodenum releases hormones that cause the gallbladder to contract and excrete bile, which travels through the bile duct to the duodenum to help with fat digestion and vitamin absorption. Gallstones are participation deposits of bile, though it is unclear what causes gallstones to form.
• Cancer: tumors in the bile duct or pancreas may cause bile duct obstruction.

• Jaundice: a bile duct obstruction stops bile from travelling to the duodenum, and instead causes it to flow backwards and accumulate in the liver and be absorbed into the blood. Patients may see their eyes and skin turn yellow, leading to jaundice. Due to a rapid increase of bilirubin in the body, patients may also pass pale-coloured stool and dark yellow (tea color) urine.
• Acute cholangitis: the presence of a bacterial infection can develop into acute cholangitis. Patients will experience pain in the upper right abdomen, fever, chills, shaking, nausea or vomiting, and fatigue. Bacteria penetrating into the bloodstream may lead to sepsis, which can be life-threatening if not immediately treated.

Treatment of bile duct obstruction varies depending on the cause.

• Caused by gallstones: if the obstruction is caused by gallstones entering the bile duct, patients may undergo an ERCP endoscopic retrograde cholangiopancreatography to remove the gallstones. They may also consider laparoscopic cholecystectomy, which is a minimally invasive surgery to remove the gallbladder, to prevent the recurrence of gallstones. In some patients, the bile duct obstruction occurs high up inside the liver bile duct itself, which may be caused also by primary ductal stones inside the liver. If these conditions cause recurrent bile duct infection, patients may consider removing the diseased segment of the liver.
• Caused by cancer: if bile duct obstruction is caused by cancer, further examination is required to determine the location and stage of cancer before an appropriate treatment method is recommended. The goal of surgery is to remove the tumor and any surrounding tissue that may contain cancer cells.
• Cholangiocarcinoma (bile duct cancer): treatment may involve removal of affected tissue including the bile duct, pancreas, duodenum, gallbladder, stomach and even liver, as well as cancerous tissue and lymph nodes.
• Pancreatic cancer: treatment may involve removal of the head of the pancreas, part of the small intestine, the gallbladder, and part of the stomach.

Both pancreatic cancer and bile duct cancer are complex diseases, treatment should tailor to individual situations. Patients should discuss with their doctor the most appropriate treatment option for them.